PRE 2010 DOCSAQn,e, aeon,.—�., .�r.q �`i,.a. w...., RP Fes'^'- not l,: ,.:. '}`'F`^: .••;n^".i. 1'+n, '0 rs.b�,..d,i sT,Jv sin. ^ver?.-�'.en;p� ^S
.: �o �O�AtuS$�s:�7 1�:�3 ii�•:¢�Cic�:.. a t+•..nWaaa• �'.s.dF� �e�a,;c;.ra Va9`e��sts['v •cep ��d�dri srsu8i•Yti a�B oaG a:.�s�,•iim wSlf"i�iri ._
PARTIAL RATE SCHEDULE
GRA v 17 T WARM AM MITE TOTAL
Ftrraace sl -.01 a Durt w0ek .$10.00 �
Replscement of FLrnare 6.00
Repair` & Aftctat:ons- up to 3500.04 570 $
Repairs & Alt.-ratiens each add. 3500.00 3W $___,____
Flrrnsee Shell & Duct Work to I20,M BTU $10 $
esah add. 60.000 BTU SM S
RepIBee-nest of Psrn ce 6.00 S
Repairs & Alte-at5ons--up to $500.0 6.00 $
Repairs f Alterations each add. 4300.00 3.00 $
STEAM ca HOT WATER SYSTEM
F`-rnace Shell & L:nes--to 40-0 sq. ft FMR Steam e10.00 $
Furnace Shell Sc LinP -•to 640 sq ft. EDR Hot Water 1000 S.
Each acid 20 sq. ft EDR Steam Ron $
Each add. 320 sq. ft EDP. Hot Water 3.00 S
OIL BrlRNZ11-to 3 gal. per hour
over 3 gal. per hour --Sac 1,-e Schedule
GAS BURNER (up to L�,00O BTU)
over 153.0M BTU Sae Fee Saedule
GAv FITTING r=. . No RATE �TOTAL
%S 200 S -.
— x .75--
xS 5.00 S
State Surcharge QQ .50
R�
ace Too SCE&L-2k
'i''taTAZ. r=
6.00 S.
5.00 $ O
PJ
Ist 3 lnxtures
Additional Flrtures
Gas Range to 19,0M
-P.M C-0..14DITIC?NITGr
' 'i•"i.rL=L G ST31-1L4
ALaa. ATMITIS & %XPA+*3S
�TOFS
LCapt. of 01clgs. P'noc►a S ?-V.S3
,5 -*-l9-
t
City of Ft.-ldley:
The imdersir;ned hereby makes application for a permit !or the work hereif*
specified agreeing to do all work in strict accordance with Che City Ordixancft
and rtiling•of the Department of Buildings, and hereby declares that an the fircoa
and repr-rsnntatiuns stated in this application arc true and correct -
Owner
Kind of Building
Used as .
To be completed about
Es!i�nated Cost:, S
Old New. Building Permit No. _.__ __ Permit No.�s
IMSC MM N OF WDA
HEATING or FOWrR F''..ANTSP--,Stearn, Foot Water, Warm Alr-No._
Trade Name - Sine No. � , /.50
iv
Capacity __. —_ Sq. 3r L £.D.R BTU XF
Total Connected Load _ FL rA of r uel
BURNER - TrVde Na Sim Pdo
Capacity
(MAl as -c"11
stoma_._
LIZ
m
SUBJECT
RE-ITINADv.
City of Fridley
1483
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
ECEIPT NO.
S
COMMUNITY DEVELOPMENT DIV.
r ~ PROTECTIVE INSPECTIONSEC.
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�•"' �'� 612-560-3450
910-F15
8/4/78
JOB ADDRESS 4519 - 2nd Street N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
10
2
Rearrang. of Blks. 13,14,1.5, Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Gareth Iverson 4519 - 2nd Street N.E..
560-6296
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
t101 Storagn Shed
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
ISTALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
$200
$.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$ 7.50
PLAN CHECK FEE
TOTAL FEE
$8.09
S 'NATUR OFC NTRACTORO AUTHORIZED AGENT (DATE)
WHEN PROPERLY
„ BLDG. INSP
VALIDATED
THS IS YOUR PERMIT`
� C5
DATE
SIGNATURE OF O IIF ER BUILDER) IDATEI
m
CITY OF FRIDLEY
APPLICATION FOR RESIM-ENTIAL BUILDING PERMITS
(NEW, ALTERATIns, ADDITIONS, OR REPAIRS)
OWNER:
Address:'
No. ✓ 1
LOT:
COMER LOT:
Street:
BLOCK:
I14SIDE LOT:
13UIL1)E11:
Address:
mei M-
SETBACK: SIDEYARDS:
Applicant attach 'to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
r-
Front: �� Depth: � Height:
Square Feet:- Cubic Feet:
Front: Depth: Height:
Square Feet: < Cubic Feet:
Type of Construction: l Estimated Cost: $
To Be Completed:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stwted in this application
are true and correct. See reverse.sl4n--9-6r addi onal information.
DATE: SIGNATURE
Stipulations:
�2a k �
01
SUBJECT
PE IT NO.
City of Fridley
16 818
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
�
_ COMMUNITY DEVELOPMENT DIV.
(�
r 1 PROTECTIVE INSPECTION SEC.
2 7 /O
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L J\ 612-571-3450
910-F15
10/12/82
JOB ADDRESS 4519 - 2nd Stmt N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
10
2
Rearr. of Blks. 13,14,15, Plymouth SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Gareth N. Iverson 4519 - 2nd Street N.E. 572-1630
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO,
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 24' x 24' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway. Agreement to be signed by neighbor.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$5,932
$2.97
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$58.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$61.47
SIGN TURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT
/0 -/'a".��- .
ion -J,/ ®
BLDG INSP 'DATE
SIGNATURE OF OWNERIIF OWNER BUILDERI (DATE)
01
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIU4 FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER: , G-�
/a g rr Gh ml�
s� BUILDER:
gI%�c . ��. /`f,_�s`
Corner Lot:
Insiac Lot:
ADDRESS: ,
s - "�d f lyl�c
ADDRESS:
TEL N0: -
- /' ,� a
TEL NO:
Construction location
• STRITT NO: � 5 / - STREET:
LOT:
BLOCK:
ADDITION: _r r2iG
gI%�c . ��. /`f,_�s`
Corner Lot:
Insiac Lot:
Setback:
Sideyards:
Applicant attach to this fossa two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: ,c/ �-a Depth: 2-1 I=1- Height: � b
Square Feet: Cubic Feet: 5 -
Front:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: Cl r�-�-� Estimated Costa ?�
Tb Be Cbrapleted:
Alt. A Alt. 8
Proposed Driveway Width If New Opening Is Desired:
SEE REVERIE SIDE OF SHEET
Tile undersigned hereby makes application for •
pp permit for the »ork'herein specified,
agreeing to cb ,all work in strict accordance with the City of Fridley Ordinances and
ruling, of the De1x-irtznent of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: lV -/Z - 1.� SIGNMIE:
stipulations
�y� C�
AGREEMENT
. T owner of the property
located athave no -objection to the
City allowing the construction of a Z:�F22 a1 / to be
located at , - Z N'{� without the required
certificate of survey that the City ordinarily requires for all-new
construction. '
a
Signature
a
Address
/e a
Date
Witness i
r
SUBJECT
P -
City of Fridley
17 2 6 6
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
i
0 is_5
�
' COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
----1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DQ�T�28/3
y 8
PAGE OF
APPROVED BY
612-571-3450
910-F15
XIKX��EXIEXX
JOB ADDRESS 4519 2nd Street N.E.
1 LEGAL
LOT PO
BLOCK .z
TRACT OR ADDITION SEE ATTACHED
earcangement of Plymouth
DESC O
X
SHEET
2 PROPER YOWNER MAILADDRESS ZIP PHONE
Gareth N. Iverson 4519 2nd Street N.E. 572-1630
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
SAME
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION )p REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
reside with masonite XXX>XXX§X siding
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
masonite
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATAQI�j�
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
UU��JJ . 00
. 50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
15.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
HEN PROPERLY VALIDATED THIS IS YO PE MIT
7 rj
BLDG WSP DATE
iGNATURE OF OWNER OF ER BUILDER) IDATEI
CITY OF FRIDLEY
APPLICATIM FOR RESIDENTIAL BUILDING PERilITS
(New, Alterations, Additions, or Repairs)
Effective Aug. 1, 1981
OWNER: e� 1y j',,& dam, BUILDER: 06 in 14-10,
ADDRESS: ADDRESS:
TEL R0: --- �! TEL 110:
Construction Location
STREET NO: STREET:
IAT: BLOCK: X ADDITION: AC&A Agg ^ !% '6 Q �r
Corner Lot: Inside Lot: AL Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOR OF CMISTRUCTIM
Front:
Square Feet:
Depth: Height:
Cubic Feet:
Front: Depth:
Height:
Square Fent: Cubic Feet:
v
Type of Construction: Estimated Cost: $
Zb Be Cbripleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE P.F.VERSI: SIDE OF SHEET
1Sie undersigned hereby makes application for a permit for the %:ork herein specified,
agreeing to do.all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
PATE: SIGNATUIE :
Stipulations:
/,S— JZ%
'CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
JOB ADDRESS_
The undersigned hereby makes application for a permit for the work
Rate TOTAL herein specified agreeing to do all work in strict accordance with the
city codes and ruling of the Building Division, and hereby declares
$ 20.00$ '� that all the facts and representations stated in this application are
true and correct. 7- 16
$ 10.00 $
OWNER ssa
$ 10.00 $
BUILDING USED AS -
$10.00
S
$10.00 $
$ 10.00 $ !
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
ESTIMATED COST 4 ®<=: PERMIT NO— ,
DESCRIPTION OF FUR D OR BURNER
No. of Heating Units_
qIrcle am) (Hot Water) arm Air
Trade Name :J. -.e
-, o.VVc ize No. �,rQ
BTU ;Z
HP EDR
Fuel A2,±7
Total Connected Load I
Burner Trade Name
Size No.
BTU
HP EDR
&3 z ?� ��� �''�'�AAMW HOME ENERGY CENTER
HEATING COMPANY
°�� ' a� � 14505-21STAVE.NO;
PMOUft MN
Signed By i�,
el No. 1,7g� f d''o
Approved By
Rough -In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes
(A)
No ( )
2.
Is free from rust or deterioration
Yes
(n)
No ( )
3.
Has no foreign objects lodged within
Yes
(v\)
No ( )
4.
Is securely supported
Yes
No ( )
5.
Meets all current Code requirements for
size and total BTU's connected
Yes
No ( )
6.
Has total heating BTU's of
All other BTU's AI
TOTAL BTU's
Remarks
List Alterations Being Done:
fthA I V G COMPANY U V
Signed By
Date V-- r - 95
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On August 1, 1995
APPLICATION FOR PLUMBING AND CAS FITTING PERMIT -
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO. RATE
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas**
_ $10,00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
a r
�
PLUMBING FIXTURE RATES: NO. RATE
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas**
_ $10,00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $42.00/Hr.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture orAppliance
State Surcharge
TOTAL FEE
TOTAL JOB ADDRESS
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated In this application are true and correct.
,1995
Owner' P >
Building Used As J
Estimated cost 4 00 - do PERMIT NO. f 4-Az�/
PLUMBING C PANY
,A�
'4L .2�
SIGNED BYe` -4 TEL N0. 7�
Approved Rough -In Date Final Date
.50
QQ-6D PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 5004(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
CITY OF FRIDLEY PERMIT NO.: 2004-01498
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 09/01/2004
572-3604 k'AX: (763) 571-12117
ADDRESS : 4519 2 ST NE
PIN : 263024330110
LEGAL DESC : REAR BL 13,14 & 15 PLYMOUTH
: LOT 10 BLOCK 2
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114 -
OWNER
PAULSON GARY I & SONJA M
4519 2ND ST NE
FRIDLEY, MN 55421
ELEC PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 117431
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg
Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.